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S. Malviya, Voepel-Lewis T, Eldevik OP, Rockwell DT, Wong JH, Tait AR. British Journal of Anaesthesia 2000; 84: 743-748. (Accompanying editorial 713-714)

Review: The authors preformed a prospective collection of quality assurance data for children who were sedated (n=922) or administered general anesthesia (n=140) for MRI or CT scans. The data collected included subject demographics, concurrent medications, adequacy of sedation, adverse events and requirement for escalated care. For sedation cases, sedatives were ordered at the discretion of the child's primary care physician. "Trained" pediatric nurses under the supervision of a radiologist administered sedative agents. General anesthesia was preselected for previously failed sedation (28%), potentially failed sedation (32%) and for perceived medical risk (14%).

Sedation was inadequate for 16% of children and failed in 7% of children. Failed sedation was associated with greater age, higher ASA status, and the use of benzodiazepines as the sole sedative agent. Hypoxemia (decrease in Spo2 by 3 10% of baseline for 3 30s) occurred in 2.9% (27/922) of sedated subjects. Each of these patients returned to baseline saturation with minor interventions. Excessive motion was noted in 12% of sedated subjects and 0.7% of general anesthesia subjects.

Comments: This study points out the pitfalls of pediatric sedation for MRI and CT scans. Failed sedation for these scans is extremely costly in terms of both time and money. The unreliability of sedation versus general anesthesia is a focal point of the article. As the editorial points out, the high rate of inadequate scans and failed sedation may point to inadequacies in the training of sedation nurses and the lack of a standardized sedation process.

Reviewed by: Jeffrey Galinkin, MD
Children's Hospital of Philadelphia